title: Risk factors for nephrotoxicity in patients receiving outpatient continuous infusions of vancomycin in an Australian tertiary hospital.
abstract: OBJECTIVE
  To assess the risk factors for nephrotoxicity caused by vancomycin continuous infusion in a predominantly Caucasian outpatient population.
  
  
  METHODS
  This was a retrospective cohort study of 155 patient episodes from December 2006 to December 2011.
  
  
  RESULTS
  Vancomycin-associated nephrotoxicity (VN) occurred in 26 of 155 (17%) patient episodes. After adjustment for baseline renal function, maximum steady-state vancomycin concentrations ≥32 mg/L [OR 8.7 (95% CI 3.1-29.6), P < 0.001] and angiotensin receptor blockade [OR 9.78 (95% CI 3.1-39.4), P < 0.001] were independently associated with VN. The cumulative dose and duration of vancomycin therapy were not independent predictors of VN.
  
  
  CONCLUSIONS
  Cessation of angiotensin receptor-blocking medications in selected patient groups, enhanced monitoring and establishing target steady-state concentrations <30 mg/L to avoid excessive vancomycin exposure may reduce the risk of VN.
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia (WA), Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Norton
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ingram
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001315:Australia; D015331:Cohort Studies; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D051437:Renal Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: OPAT; angiotensin blockade; steady-state concentrations